Tobacco Use and Cessation Among Asian Oregonians...43 Recommendations 1. Improve media and public relations Increase awareness of Quit Line among Asian Oregonians Advertise about the

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Tobacco Use and Cessation Among Asian Oregonians

IRCO/Asian Family CenterNPC Research

Nga-My VuongAPI TPEP Coordinator

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Agenda

IntroductionBackgroundPhase I: Mail SurveysPhase II: In-Depth InterviewsRecommendationsDiscussion

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Introduction

Primary Research TeamAsian Family Center/IRCO TPEP StaffNPC Research

ConsultingAPI Health Network DHS TPEP & Self-management TeamsCommunity members

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Introduction

Gaps in Knowledge1. In Oregon, no good estimates of tobacco use

among various Asian ethnic subgroups2. Do not know why Asian Oregonians do not

use Oregon’s Quit LineOregon Quit contract, 07/01/08-3/31/09, shows:

Caucasian-2929African-American-101Chinese-1,Filipino-2, Japanese-3, Korean-4

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Introduction

GoalsCollect information about tobacco use & cessation utilization among Asian Oregonians

Examine how demographics, perceptions of harm, cultural factors, and linguistic acculturation relate to tobacco use and cessation

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Background

What is the Problem?

National data shows that APIs have the lowest tobacco use in the U.S., BUT certain ethnic and gender subgroups have much higher tobacco use than the national average.

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Background

Tobacco Use Rates vary

2.1% for Chinese women to 31% Korean men (Lew & Tanjasiri, 2003)

35%-56% for Vietnamese men to 47%-72% Cambodian men(Ma et al., 2005 )

BUT, not clear why…

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CBPR MethodologyCommunity Based Participatory Research

Approach to research & evaluation that engages community stakeholders in each project phase

Promotes shared learning & power

Iterative process

Values community expertise, traditions,

priorities

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Phase I – Mail Survey (2007-08)

Brief assessment of tobacco uselinguistic acculturationperceptions of harmattitudes toward and use of cessation resources

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Phase I: Mail SurveyInstrument development1. The Center for Disease Control and

Prevention’s Behavioral Risk Factor Surveillance System

2. The California Korean American Tobacco Use Survey

3. Hmong Tobacco Cessation and Prevention Survey

4. The North American Quit Line Consortium’s Minimal Data Set Intake Questions

Iterative process with Research Team

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Phase I: Mail Survey2-page mail survey10 counties in Oregon7 languages: Chinese, Japanese, Korean, Vietnamese, Tagalog, Lao, and MienhTranslation process challenges: Chinese, Tagalog, Korean and Mienh$2 cash included for participation + $100 lotteryInitial sample = 1,291

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Phase I: Sampling DesignUsed 2005 Census to identify 10 counties with more than 500 residents of Asian-descentMultnomah 37,638 Benton 3,506Washington 29,752 Jackson 1,631Clackamas 8,292 Deschutes 849Lane 6,470 Malheur 619Marion 4,997 Umatilla 530

Included representation from Eastern and Southern parts of the State

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Phase I: Mail Survey Methods

Purchased addresses from Survey Sampling InternationalAddresses randomly selected within each countyLess expensive than other data collection methodsResponse rate: 44% (491 out of 1,121)61% men, 36% women (3% missing)

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Phase I: Mail Survey Results

Number in parentheses = # respondents of that ethnicity 14

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Phase 1: Mail Survey Results

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Number in parentheses = # respondents in that age group 16

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N=432

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Prevalence12.6% currently smoke cigarettes14.0% currently use some form of tobacco

8.6% current smokers (BRFSS definition)100+ cigarettes & currently smoke cigarettes

Smoking prevalence among Asian and Pacific Islanders was 10% (DHS, 2004-05)

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Number in parentheses = # respondents of that ethnicity19

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Number in parentheses = # respondents in that age group* Indicates significant difference

N=425

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Number in parentheses = # respondents of that gender* Indicates significant difference 21

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N=426

Number in parentheses = # respondents from that region* Indicates significant difference 22

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Phase I: Mail Survey Results1. Asian Oregonians’ knowledge of Quit Line

compared to statea) 43% of Oregonians in 2007b) 34% of Asian Oregonians participating in this

study

2. Heard of Quit Line - current smokersa) 60% of Oregonians in 2007b) 56% of Asian Oregonians participating in this

study

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Number in parentheses = # respondents of that ethnicity

N=405

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Number in parentheses = # respondents of that gender

N=405

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Number in parentheses = # respondents with that level of education

N=410

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Number in parentheses = # respondents from that region

N=413

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Phase I: Summary

Smoking prevalence differs according to demographicsKnowledge of Quit Line differs according to demographicsOne-third of Asian Oregonians completed survey in their native languageLower knowledge of Quit Line among Asian Oregonians than statewide estimates (similar for smokers)

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Phase II –Interviews (2008-09)

In-depth assessment of attitudes toward tobacco usecultural use of cigarettesacculturation, perceptions of harmmotivation to quitknowledge & utilization of cessation resources

Goal: Compliment and enrich information collected through mail survey.

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Phase II: Instrument Development

Mix of 54 qualitative and quantitative questions adapted from:

Behavioral Risk Factor Surveillance System (BRFSS)Diverse Racial & Ethnic Groups and Nations (DREAGAN) StudyHmong Tobacco Use Survey The California Korean American Tobacco Use Survey

Iterative process with Research Team

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1. Word of mouth2. Advertisements in local Asian ethnic

newspapers : the Asian Reporter, The Portland Chinese Times, and the Korean Times

3. Posting fliers at Asian Grocery stores and community centers

4. Local community events: New Year events, community festivals, and Health Fairs

Phase II: Recruitment

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Phase II: Participation Criteria

Identified as Asian, 18 years or older, and current smokers Purposeful in recruiting participants from different age groups, ethnic subgroups, gender, educational attainment, economic status, and acculturation statusConducted in English

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Phase II: Interview Process

1. Face-to-face interviews2. Private area: AFC or their homes3. Digital recorder4. Transcribed5. $20 gift card as incentive6. Length of interview: 30-60 minutes

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Phase II: Results

19 participants - 11 male, 8 femaleAge range: 18 to 47Ethnic diversity: 8 different ethnic groupsAverage length of time in the US:24 years63% spoke mostly English at homeSupport smoke-free housing policies

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Phase II Results: What would help you quit?

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Phase II Results: Knowledge of Oregon’s Tobacco Quit Line

Of the 19 interviewees:63% heard of the Quit Line (n=12)5% considered calling: (n=1)0% ever calledUncertain about the exact source of the QL

knowledge

“…it was either TV after one of those commercials or it was on the radio. I think I’ve heard both.”

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Phase II Results: Reasons for Not Calling Quit Line

1. Not knowing enough about the services offered

“I don’t know what they do. I mean do they have counselors there or? I don’t know. I just think…If I wanted to quit that bad I don’t need help. It is just mental thing.”

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2. Not wanting to discuss with an unfamiliar person – prefer to keep sensitive information within the family

“We don’t believe in counselors. We just don’t.”

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3. Discomfort using the phone for counseling

“ I don’t think a counselor- I mean, a counselor in person wouldn’t help so over the phone…definitely I don’t think it would do too much.”

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4. Seeking help from others is a sign of weakness

“ I think some guys probably find it embarrassing. I mean probably because they don’t want other people to see their own weaknesses.”

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Phase II: Additional Findings

Men vs. Women“It is a gender status thing where it is hard

for men in the community to ask for help for anything.”

“I think they are more open to it because a lot of the women, they know that smoking is bad, especially if they have kids and stuff.”

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Phase II: Additional Findings

Cold turkey: no direct questions but emerged among several interviews

“ What I do is my own business. And if I decide to quit smoking I will quit on my own. The ‘I will do it’ mentality…it is just we don’t ask for help, we do it all by ourselves.”

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Recommendations

1. Improve media and public relationsIncrease awareness of Quit Line among Asian OregoniansAdvertise about the specific services offeredHighlight the accessibility of the service and the philosophy used by Quit counselorsTarget messages (Asian ethnic groups, different beliefs about risk of tobacco use, gender, age, English language proficiency)Translation (Chinese, Vietnamese, Korean, Lao)

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Recommendations

2. Diversify Quit Line services and increase use of Web Coach

Advertise the Web coach as a prominent feature of the Quit Line, and explain how to gain accessTranslate information about the language capabilities of the QL and have this information posted on the Oregon TPEP Web siteContinue to explore diversification of cessation services

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Phase II: Recommendations

3. Deliver quit messages through healthcare providers

Increase healthcare provider’s awareness of API tobacco use ratesPromote and explain cessation optionsIncrease outreach to healthcare providersAddress the model minority mythTranslated materials

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Dissemination of ResearchAPHA Annual Meeting; Roundtable Presentation (Oct.08)

SOPHE Conference; Poster Presentation (Oct. 08)

Intercultural Cancer Conference; Poster Presentation

API Health Network Presentation (Dec. 08)

Demographic Differences in Tobacco Use & Utilization of Cessation Resources Among Asian Oregonians (Jan.09)

Asian Oregonians’ Attitudes Toward the Tobacco Quit Line (June, 09)

Acculturation, Perceptions of Harm, and Cigarette Smoking among Asian Oregonians (submitted AJPH, June 2009)

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Discussion

Comments?Questions?Suggestions?

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Thank you for your support!

For additional info, please contact:

Nga-My Vuong, [email protected], 503-235-9396 x 121

Elizabeth Takahashi, [email protected], 503-988-3663 x22660

Jennifer Kue, [email protected], 503-235-9396 x 104

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Tobacco Use and Cessation Among Asian Oregonians...43 Recommendations 1. Improve media and public relations Increase awareness of Quit Line among Asian Oregonians Advertise about the